A potent mix of ideas attracted many of us to psychoanalytic psychology in the 1950s and 1960s. Psychology had evolved as an attempt to “scientize” the philosophical problems of action, knowledge, and evil; volition, thought, and feeling were its subject matter. Mainstream American psychology had, ironically, come to be dominated by a radical focus on action (behaviorism) that negated volition while dismissing unobservable thoughts and feelings. Its clinical psychology branch, however, addressed the problem of evil, with psychoanalytic ideas comprising the primary paradigm.

Psychoanalytic practice was then a virtual medical monopoly in the United States, but its ideas were not to be contained by a medical model. Important scholars in psychology like Jerome Bruner had come under the influence of psychoanalytic thought; psychoanalytic psychologist David Rapaport and his students were organizing ego psychological propositions so as to subject them to empirical study. Psychiatry, led by psychoanalysts, was attempting to meld psychodynamic thinking with its more traditional psychiatric nosology and treatments. For those of us inclined to pursue it, there was a developing and vital psychoanalytic psychology, allied neither with a sterile behaviorism nor with medical psychiatry.

One young contributor to this psychoanalytic psychology was David Shapiro. In his classic 1965 treatise, Neurotic Styles, he impressed us with gripping clinical descriptions and penetrating thought. He made it clear that understanding “styles” need not result in diagnosis-driven treatment. He emphasized the uniqueness of each therapy patient as central in any clinical situation. Commonalities and differences among and between styles could be discerned though, with the insights gained providing helpful things to say to our patients. Although not associated with any particular school of psychoanalysis, Shapiro’s first book was must reading for any serious would-be clinician at the time, and to my mind it still is.

For nearly four decades, David Shapiro has continued to work the soil he first furrowed. Still an individualistic thinker (with an academic position on one coast or another), he has remained true to his initial interests. In his current offering, he presents the boldest extension of his thinking to date. He compares neuroses and psychoses in what becomes an impressive challenge to the current trend to see the latter as solely a set of biological conditions; and he does so by maintaining his long-time focus on volition, or (in his preferred terms) decision-making, self-regulation, responsibility, and agency.

For Shapiro, “defensive self-estrangement” marks all forms of psychopathology. Self-deception and lack of planning are its important elements. Symptoms are not specifically related to trauma or to biology; instead they manifest a whole character. Self-estrangement is exhibited in the different forms of passive-reactive, rigid, and driven character types, each with varieties. Anxiety-laden situations do not provoke defense; instead, defense results as character exaggerates trivial situations. Shapiro presents a theory of character development in which affects trigger action only for the infant. As development ensues, conscious intention and will power evolve while more mature and complex motives provide context for responding to immediate situations. Defenses are part of character rather than mechanisms employed by it. Actions emerge from choice and responsibility, as well as from conflict and anxiety. Adults do not passively act out biological programs or family dynamics; nor do they regress. Instead they act adaptively or defensively, sometimes using pre-volitional modes. In more severe disturbances, defenses are extended and exaggerated, rather than broken down. Loss of reality sense, blurring of self-object differentiation, degradation of affective experience, and limitation of volitional direction are all characteristic of neurotic as well as psychotic conditions.

In what amounts to a major reformulation of several tenets of current theory, Shapiro presents a holistic, humanistic perspective on character pathology and the workings of the mind. He does not merely assert alternate positions. His views are supported by numerous examples from descriptive psychiatry and clinical wisdom, by reference to ideas derived from both psychoanalytic and psychological thought and empirical study, and by refined argumentation. He neither minimizes nor avoids the complexity of the ideas he discusses, and he acknowledges the incompleteness of both his formulations and the current understanding of psychopathology, especially psychosis.
Shapiro’s reformulation is specifically directed at (and within) modern conflict theory. He does not address relational theories, object relations approaches, self-psychology, or other models extant in today’s psychoanalytic pluralism. Nor does he address matters of technique except by asserting the principle that an incorrect message is given when models not based on “agency” guide our thinking. Shapiro does not deal with current “hot topics” in psychoanalytic psychology: two-person psychology, self-disclosure, gender issues, social issues, therapeutic outcome, or empirical validation. His work evokes (for me) the fundamental and still exciting issues of the 1950s and 1960s.

Shapiro’s work is unusual also for its emphasis on two matters commonly overlooked by psychoanalytic theory: action and consciousness. Behaviorism devoted itself to the study of action only. Psychoanalysis emphasizes internal psychological events prior to action. Shapiro notes his dissatisfactions with Schafer’s earlier attempt (1976) at developing an “action language” to emphasize agency, but finds the even earlier psychoanalytic views of Hellmuth Kaiser (1955) on responsibility to be consistent with his own. Cognitivism, American psychology’s current paradigm, devotes itself to conscious (usually rational) experience. For many psychoanalysts, “the unconscious” is the core of psychoanalysis, despite more modern and now long-standing structural theory. Action and consciousness are then seen as preoccupations of an anti-psychoanalytic American psychology. Shapiro attempts to reorient psychoanalytic psychology by giving equal respect to the three problems central to the original evolution of psychology from philosophy.
Shapiro’s bibliography may seem timeworn or unfamiliar to contemporary readers, while warming the hearts of those of us still taken with the ideas of mid-century psychoanalytic psychology. 75 of his 89 citations predate 1990. They include early psychoanalysts like Abraham, H. Deutsch, Erikson, Fenichel, the Freuds, Guntrip, Nunberg, Rapaport, and Waelder. Inspiration from psychiatry comes from Andras Angyal, Arieti, Bleuler, Freeman, Sechehaye, and Sullivan. Lewin, Piaget, Werner, and Kurt Goldstein are psychologists cited. A more contemporary source is Louis Sass, whose notion of “double bookkeeping,” a clinical description of pathological thought, provides Shapiro with a helpful means of understanding schizophrenia. An unfortunate anachronism is Shapiro’s use of the male pronoun for all patients but hysterics, whom he refers to as female.

Some will find this an old-fashioned book; I find it a worthy new look at old problems yet unresolved. Some will find it narrow, focusing on complex issues through the single lens of agency; I find its ideas to be wide-ranging and evocative of Hartmann’s ambition that psychoanalysis be a general psychology. It is a small book (160 pages of text) but it is not a quick or easy read. It is all meat and sometimes tough-going. Shapiro’s clinical descriptions amply justify the price of admission; his theoretical contributions will reward the effort required to study them.